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Coronary Risk Stratification of Chest Pain

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261. Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease Full Text available with Trip Pro

in Children With CHD 2663 11.Primary Prevention and Treatment of Thrombi in Children With Arrhythmias 2666 11.1.Atrial Arrhythmias 2666 11.2.Pacemakers and Internal Cardiac Defibrillators 2668 11.3.Electrophysiology Studies and Catheter Ablation Procedures 2668 11.4.Special Considerations in Adults With CHD and Arrhythmias 2670 12.Primary Prevention and Treatment of Thrombi in Children With Acquired Heart Disease 2670 12.1.Kawasaki Disease 2670 12.1.1.General Guidelines 2670 12.1.2.Patients With Coronary (...) ), children with acquired heart disease, and in adults with CHD. High-risk groups include patients with shunt- dependent single ventricles (shunt thrombosis, 8%–12%; 4% risk of death resulting from shunt failure), postoperative central lines (13% thrombosis in central venous lines [CVLs]), Fontan circulation (17%–33% incidence of thrombosis after Fontan), arrhythmias, Kawasaki disease with coronary aneurysms, and cardiomyopathy/myocarditis. Although the prevalence, risk factors, and management of some

2013 American Heart Association

262. Social Determinants of Risk and Outcomes for Cardiovascular Disease

early-life SEP to CVD. The Mechanisms Mediating the Relationship Between Societal Conditions and CVD section provides a detailed discussion. SEP and CVD Risk Prediction Given the substantial evidence linking SEP and CVD and findings that suggest that the Framingham risk score overestimates the risk of coronary heart disease in high-SEP individuals and underestimates the risk in low–socioeconomic status individuals, recent studies have begun to evaluate the potential benefit of including SEP in risk (...) , in relation to incident coronary heart disease. After an average of 9 years of follow-up, living in more disadvantaged neighborhoods compared with advantaged neighborhoods was associated with a 70% to 90% higher risk of coronary heart disease in whites and 30% to 40% higher risk in blacks independently of individual-level characteristics (demographics, SEP, health status, and behavioral risk factors). Other longitudinal studies have documented similar association between neighborhood socioeconomic

2015 American Heart Association

263. Computed Tomography for Suspected Coronary Artery Disease

coronary angiography. Heart Lung Circ 2009;18:200-7. Ladapo JA, Jaffer FA, Hoffmann U, Thomson CC, Bamberg F, Dec W, et al. Clinical outcomes and cost-effectiveness of coronary computed tomography angiography in the evaluation of patients with chest pain. J Am Coll Cardiol 2009;54:2409-22. Jacobs JE, Boxt LM, Desjardins B, Fishman EK, Larson PA, Schoepf J. ACR practice guideline for the performance and interpretation of cardiac computed tomography (CT). J Am Coll Radiol 2006;3:677-85. Budoff MJ, Cohen (...) reserve: Implications for myocardial contrast echocardiography versus radionuclide perfusion imaging for the detection of coronary artery disease. Circulation 2008;117:1832-41. Douglas PS, Ginsburg GS. The evaluation of chest pain in women. N Engl J Med 1996;334:1311-5. Lerner DJ, Kannel WB. Patterns of coronary heart disease morbidity and mortality in the sexes: a 26-year follow-up of the Framingham population. Am Heart J 1986;111:383-90. Gibbons RJ, Balady GJ, Bricker JT, Chaitman BR, Fletcher GF

2011 Swedish Council on Technology Assessement

264. Incremental diagnostic and prognostic value of contemporary stress echocardiography in a chest pain unit: mortality and morbidity outcomes from a real-world setting. Full Text available with Trip Pro

; 95% confidence interval, 2.15-7.72; P<0.001) and advancing age (hazard ratio, 1.78; 95% confidence interval, 1.39-2.37; P<0.001) predicted hard events in multivariable regression analysis.SE incorporated into a chest pain unit has excellent feasibility and provides rapid assessment and discharge with accurate risk stratification of patients with suspected acute coronary syndrome but nondiagnostic ECG and negative 12-hour troponin. (...) Incremental diagnostic and prognostic value of contemporary stress echocardiography in a chest pain unit: mortality and morbidity outcomes from a real-world setting. Clinical assessment often cannot reliably or rapidly risk stratify patients hospitalized with suspected acute coronary syndrome. The real-world clinical value of stress echocardiography (SE) in these patients is unknown. Thus, we undertook this study to assess the feasibility, safety, ability for early triaging, and prediction

2013 Circulation. Cardiovascular imaging

265. Shared Decision Making in the Emergency Department: Chest Pain Choice Trial

of cardiac testing, and total healthcare utilization. Condition or disease Intervention/treatment Phase Chest Pain Acute Coronary Syndrome Other: Chest Pain Choice Decision Aid Not Applicable Study Design Go to Layout table for study information Study Type : Interventional (Clinical Trial) Actual Enrollment : 898 participants Allocation: Randomized Intervention Model: Parallel Assignment Masking: Double (Investigator, Outcomes Assessor) Primary Purpose: Health Services Research Official Title: Shared (...) arm (no decision aid used) Outcome Measures Go to Primary Outcome Measures : Test if Chest Pain Choice Safely Improves Patient Knowledge. [ Time Frame: Directly following intervention (on day 1) ] Patient knowledge was measured by immediate post-visit survey that included 8 questions about the patient's risk for acute coronary syndrome and the available management options. Secondary Outcome Measures : Test if the Decision Aid Has an Effect on Healthcare Utilization Within 30 Days After Enrollment

2013 Clinical Trials

266. ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 Appropriate Use Criteria for Coronary Revascularization Focused Update

ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 Appropriate Use Criteria for Coronary Revascularization Focused Update 1 © 2012 by the American College of Cardiology Foundation, the American Association for Thoracic Surgery, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons. 2012 ACCF/AATS/SCAI/STS Expert Consensus Document on Transcatheter Aortic Valve Replacement Developed in collaboration with the American Heart Association, American Society (...) of Echocardiography, European Association for Cardio-Thoracic Surgery, Heart Failure Society of America, Mended Hearts, Society of Cardiovascular Anesthesiologists, Society of Cardiac Computed Tomography, and Society for Cardiovascular Magnetic Resonance Writing Committee Members David R. Holmes, JR, MD, FACC, Chair* Michael J. Mack, MD, FACC, Vice Chair† Sanjay Kaul, MBBS, FACC, Vice Chair* Arvind Agnihotri, MD‡ A. Pieter Kappetein, MD, PHD** Karen P. Alexander, MD, FACC* Jane A. Linderbaum, MS, CNP, AACC

2012 Society for Cardiovascular Angiography and Interventions

267. Decision Making in Advanced Heart Failure

to be done, because risks are thought to outweigh potential benefit HF indicates heart failure; LVEF, left ventricular ejection fraction; CABG, coronary artery bypass grafting surgery; IABP, intra-aortic balloon pump; MCS, mechanical circulatory support; PCI, percutaneous coronary intervention; CRT, cardiac resynchronization therapy; ICD, implantable cardioverter-defibrillator; VAD, ventricular assist device; ECMO, extracorporeal membranous oxygenation; and IV, intravenous. 1934 Circulation April 17 (...) , 2012 Downloaded from http://ahajournals.org by on March 27, 2019initial approach to stage D heart failure is optimization of these treatments. The need to decrease or discontinue neuro- hormonal antagonists is a milestone, as described in Table 4. Major Interventions That Might Improve Cardiac Function and Clinical Outcomes High-Risk Cardiac Surgery Patients may be considered for cardiac surgery for coronary, valvular, and pericardial disease. These surgeries are partic- ularly high risk

2012 American Heart Association

268. 2012 ACCF/AHA/HRS Focused Update Incorporated Into the ACCF/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities Full Text available with Trip Pro

2019 January 2019 January 2019 January 2019 January 2019 This site uses cookies. By continuing to browse this site you are agreeing to our use of cookies. Free Access article Share on Jump to Free Access article 2012 ACCF/AHA/HRS Focused Update Incorporated Into the ACCF/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society (...) , MD, FACC, FHRS , MD, FACC, FAHA, FHRS , MD, FACC, FHRS , MD, FACC , MD, FACC , MD, FACC, FAHA, FHRS , MD, FACC, FHRS*The 2012 writing group members were required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 4 for recusal information.; †ACCF/AHA Representative.; ‡Heart Rhythm Society Representative. §ACCF/AHA Task Force on Performance Measures Liaison. ‖American Association for Thoracic Surgery

2012 American Heart Association

269. The Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease

) Australian Indigenous Doctors’ Association (AIDA) Australasian Society for Infectious Diseases (ASID) Council of Remote Area Nurses (CRANA) Cardiac Society of Australia and New Zealand (CSANZ) Internal Medicine Society of Australia and New Zealand (IMSANZ) National Aboriginal Community Controlled Health Organisation (NACCHO) National Heart Foundation of Australia Public Health Association of Australia (PHAA) Royal Australian College of General Practitioners (RACGP) Society of Obstetric Medicine (...) of Australia and New Zealand (SOMANZ) The Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) The Royal Australasian College of Physicians (RACP) Copyright © 2012 Menzies School of Health Research This work is copyright. You may download, display, print and reproduce this material in unaltered form only (retaining this notice) for your personal, non-commercial use or use within your organisation. Apart from any use as permitted under the Copyright Act 1968, all other rights

2012 Clinical Practice Guidelines Portal

270. Does Coronary Artery Calcium Scoring Add to the Predictive Value of Coronary Computed Tomography Angiography for Adverse Cardiovascular Events in Low-risk Chest Pain Patients? (Abstract)

Does Coronary Artery Calcium Scoring Add to the Predictive Value of Coronary Computed Tomography Angiography for Adverse Cardiovascular Events in Low-risk Chest Pain Patients? Coronary angiography calcium score (CACS) is included for patients who receive coronary computed tomography angiography (CTA) as part of diagnostic testing for low-risk chest pain. Both tests add radiation exposure, and it is unclear whether the combination provides more information than either test alone. The objective (...) was to asses if CACS = 0 determines freedom from coronary artery disease (CAD) and whether the addition of CACS to coronary CT angiography provides additional risk stratification information or helps predict 30-day cardiovascular outcomes.This was a secondary analysis of a prospective cohort study at an urban university hospital emergency department (ED), of patients with symptoms suggestive of potential acute coronary syndrome (ACS) and low Thrombolysis in Myocardial Infarction (TIMI) risk scores who

2011 Academic Emergency Medicine

271. The 2012 Canadian Hypertension Education Program recommendations for the management of hypertension: Blood pressure measurement, diagnosis, assessment of risk, and therapy

infarction Angina pectoris Congestive heart failure Renal disease Chronic kidney disease (GFR < 60 mL per minute per 1.73 m 2 ) Albuminuria Peripheral artery disease Intermittent claudication GFR, glomerular filtration rate. Table 4 Examples of key cardiovascular risk factors for atherosclerosis Nonmodifiable Age ≥ 55 years Male Family history of premature cardiovascular disease (age < 55 in men and < 65 in women) Modifiable Sedentary lifestyle Poor dietary habits Abdominal obesity Dysglycemia Smoking (...) (Grade A) and to use antihypertensive therapy more efficiently (Grade D). In the absence of Canadian data to determine the accuracy of risk calculations, avoid using absolute levels of risk to support treatment decisions (Grade C). 2 Consider informing patients of their global risk to improve the effectiveness of risk factor modification (Grade B). Consider also using analogies that describe comparative risk such as “cardiovascular age,” “vascular age,” or “heart age” to inform patients of their risk

2012 CPG Infobase

272. Henry Ford HEART Score Randomized Trial: Rapid Discharge of Patients Evaluated for Possible Myocardial Infarction. Full Text available with Trip Pro

Henry Ford HEART Score Randomized Trial: Rapid Discharge of Patients Evaluated for Possible Myocardial Infarction. Hospital evaluation of patients with chest pain is common and costly. The HEART score risk stratification tool that merges troponin testing into a clinical risk model for evaluation emergency department patients with possible acute myocardial infarction (AMI) has been shown to effectively identify a substantial low-risk subset of patients possibly safe for early discharge without (...) stress testing, a strategy that could have tremendous healthcare savings implications.A total of 105 patients evaluated for AMI in the emergency departments of 2 teaching hospitals in the Henry Ford Health System (Detroit and West Bloomfield, MI), between February 2014 and May 2015, with a modified HEART score ≤3 (which includes cardiac troponin I <0.04 ng/mL at 0 and 3 hours) were randomized to immediate discharge (n=53) versus management in an observation unit with stress testing (n=52

2017 Circulation. Cardiovascular quality and outcomes Controlled trial quality: uncertain

273. Diagnostic Accuracy of a New High-Sensitivity Troponin I Assay and Five Accelerated Diagnostic Pathways for Ruling Out Acute Myocardial Infarction and Acute Coronary Syndrome. Full Text available with Trip Pro

and acute coronary syndrome, using the Beckman's Access high-sensitivity troponin I assay with the new Vancouver Chest Pain Rule or No Objective Testing Rule enabled approximately one third of patients to be safely discharged after 2-hour risk stratification with no further testing. The EDACS, m-ADAPT, or HEART pathway enabled half of ED patients to be rapidly referred for objective testing.Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved. (...) ) in Australia. Patients were classified as being at low risk according to 5 rules: modified accelerated diagnostic protocol to assess patients with chest pain symptoms using troponin as the only biomarker (m-ADAPT), the Emergency Department Assessment of Chest Pain Score (EDACS) pathway, the History, ECG, Age, Risk Factors, and Troponin (HEART) pathway, the No Objective Testing Rule, and the new Vancouver Chest Pain Rule. Endpoints were 30-day acute myocardial infarction and acute coronary syndrome

2017 Annals of Emergency Medicine

274. Comparison of Three Symptom Classification Methods to Standardize the History Component of the HEART Score Full Text available with Trip Pro

Comparison of Three Symptom Classification Methods to Standardize the History Component of the HEART Score The History, Electrocardiography, Age, Risk factors, Troponin (HEART) score enables rapid risk stratification of emergency department patients presenting with chest pain. However, the subjectivity in scoring introduced by the history component has been criticized by some clinicians. We examined the association of 3 objective scoring models with the results of noninvasive cardiac (...) testing.Medical records for all patients evaluated in the chest pain center of an academic medical center during a 1-year period were reviewed retrospectively. Each patient's history component score was calculated using 3 models developed by the authors. Differences in the distribution of HEART scores for each model, as well as their degree of agreement with one another, as well as the results of cardiac testing were analyzed.Seven hundred forty nine patients were studied, 58 of which had an abnormal stress

2017 Critical Pathways in Cardiology

275. CORonary MICrovascular Angina (CorMicA)

. FDA-regulated Drug Product: No Studies a U.S. FDA-regulated Device Product: No Additional relevant MeSH terms: Layout table for MeSH terms Angina Pectoris Coronary Disease Coronary Artery Disease Angina, Stable Coronary Vasospasm Myocardial Ischemia Heart Diseases Cardiovascular Diseases Vascular Diseases Chest Pain Pain Neurologic Manifestations Signs and Symptoms Arteriosclerosis Arterial Occlusive Diseases (...) Waiting Times Centre Board Study Details Study Description Go to Brief Summary: Angina is form of chest pain that is due to a lack of blood to the heart muscle. Angina is commonly triggered by stress and exertion, and is a common health problem worldwide. The diagnosis and treatment of angina is usually focused on detection of blockages in heart arteries, and relief of this problem with drugs, stents or bypass surgery. However, about one third of all invasive angiograms that are performed in patients

2017 Clinical Trials

276. A2 AR as a Novel Biomarkers for Physician Decision-making Improvement Evaluation's Patients With Suspected Acute Coronary Syndrome But Negative Troponin.

patients with biomarker testing at presentation to facilitate the clinically-appropriate rapid discharge from the emergency department of patients who present with low-intermediate risk chest pain, and conversely to triage appropriate Non sustained ST elevation acute coronary syndrome (NSTE-ACS) patients to Cardiology beds, stress and non-invasive imaging modalities. Biomarkers such as high-sensitivity troponin (hs-cTn), heart-type fatty acid-binding protein (H-FABP), CRP, brain natriuretic peptide (...) . It would be a powerful tool for risk stratification of patients presenting with chest pain but unremarkable ECG and blood tests. the investigateors therefore designed a blind multicentrique prospective study to evaluate expression and functionnaly activity of A2AR in the management of undifferentiated chest pain The objective of the study was to evaluate diagnostic accuracy between this novel biomarkers A2AR and invasive and non -invasive evaluation of patients with suspected coronary artery disease

2017 Clinical Trials

277. Acute Coronary Syndrome Screening and Diagnostic Practice Variation. Full Text available with Trip Pro

) variation in the use of noninvasive testing (NIVT) to identify obstructive coronary artery disease or detect inducible ischemia.We found that 85% of EDs utilize a formal triage protocol to screen patients for an early ECG to diagnose STEMI. Of these, 17% use chest pain as the sole criteria. For the diagnosis of NSTEMI, 58% use intervals ≥4 hours for a second troponin and 34% routinely risk stratify before troponin testing. For the diagnosis of noninfarction ischemia, the median percentage of patients (...) epidemiology study with the ED as the unit of analysis characterizing variability in the ACS evaluation across 62 diverse EDs. We explored three domains of screening and diagnostic practice: 1) variability in criteria used by EDs to identify patients for an early electrocardiogram (ECG) to diagnose ST-elevation myocardial infarction (STEMI), 2) nonuniform troponin biomarker and formalized pre-troponin risk stratification use for the diagnosis of non-ST-elevation myocardial infarction (NSTEMI), and 3

2017 Academic Emergency Medicine

278. Limited utility of exercise stress testing in the evaluation of suspected acute coronary syndrome in patients aged less than 40 years with intermediate risk features. (Abstract)

a low pretest probability of acute coronary syndrome. The utility of exercise stress testing in young adults with chest pain suspected of acute coronary syndrome who have National Heart Foundation intermediate risk features was evaluated.A retrospective analysis of exercise stress testing performed on patients less than 40 years was evaluated. Patients were enrolled on a chest pain pathway and had negative serial ECGs and cardiac biomarkers before exercise stress testing to rule-out acute coronary (...) patient declined further investigations. Assuming this was a true positive exercise stress test, the incidence of true positive exercise stress testing would have been 0.097% (95% confidence interval: 0.079-0.115%) (one of 1027 patients).Routine exercise stress testing has limited value in the risk stratification of adults less than 40 years with suspected intermediate risk of acute coronary syndrome.© 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

2014 Emergency medicine Australasia

279. Guidelines for Responsible Opioid Prescribing in Chronic Non-Cancer Pain

-cancer pain. They provided recommendations and guidance on patient selection and risk stratification; informed consent and opioid management plans, ini- tiation and titration of chronic opioid therapy, use of methadone, monitoring of patients on chronic opioid therapy, dose escalations, high-dose therapy, opioid ro- tation, and indications for discontinuation of therapy, prevention and management of opioid-related adverse effects, driving and work safety, identifying a medical home and when to obtain (...) interventions (optional) • Interventional pain management (optional) • Other alternatives • Consultation(s) as needed SIDE EFFECTS • Driving • Sedation • Constipation • Breathing INITIAL TREATMENT (8-12 WEEKS) • Stratification of risk • Understanding opioids • Initiation with low dose short-acting opioid therapy • Titrate CONTINUE • Analgesia of 30% and/or activity increase by 30% • No misuse, abuse, adverse effects (manageable) • Continue monitoring • Wean, discharge, or maintain DISCONTINUE ? Persistent

2012 American Society of Interventional Pain Physicians

280. Chronic Obstructive Pulmonary Disease

stratification Mild: FEV1 80% or greater than predicted Moderate: FEV1 <80% of predicted Severe: FEV1 <50% of predicted Very Severe: FEV1 <30% of predicted Other findings diminished in Increased Increased <350 L/min VII. Staging See VIII. Labs See and Indicated in severe or very severe COPD Alpha-1-antitrypsin indications Age under 45 years No prior smoking history of Comorbid IX. Imaging: Chest XRay See and hyperinflation Diaphragm flattening Distal pulmonary vessel tapering Increased basilar markings in X (...) Chronic Obstructive Pulmonary Disease Chronic Obstructive Pulmonary Disease Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Chronic

2018 FP Notebook

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